Making the Five Year Forward View a reality

30 March 2015

The recently published Five Year Forward View (5YFV) sets out a clear and compelling direction for the NHS. It argues that the NHS must take decisive steps to break down the barriers in how care is provided between family doctors and hospitals, between physical and mental health, and between community services and social care. It argues that we need to see far more care delivered locally, organised to support people with multiple health conditions, not just single diseases.

The challenges that the 5YFV describes are acutely felt in West Suffolk. The population we serve is ageing, long term conditions are increasing and costs as well as public expectations continue to rise. The overall population of West Suffolk is projected to increase by over 7 per cent between 2013 and 2022, with a 38 per cent increase in people aged over 70 years old.

The consequence of this challenge is that West Suffolk faces an increasingly frail and demanding elderly population with a variety of health needs. Currently this is driving large increases in unscheduled attendances and admissions to hospital. Year on year increases of non-elective admissions, for example, have risen by 9 per cent this year. If these trends continue they will challenge the future sustainability of the overall West Suffolk health system. Our GP practices are concerned about their sustainability, faced by growing patient demand and expectation, and difficulties in recruitment. Our NHS community and adult community services are facing similar challenges. Our CCG is forecasting a small surplus, but has an underlying deficit position due to the growth in demand.

The current model of provision in West Suffolk therefore needs to be transformed. If we change the service model and integrate services across the community and primary care, as well as into social care, then it might be possible to develop a sustainable service model. Our emphasis is upon creating joined up and improved pathways of care through clinical leadership and organisational integration; that is, organisational integration is the vehicle for change, not the aim of the change.

This is why we are looking to develop a primary and acute care system (PACS) in West Suffolk. The principal partners in the model are NHS West Suffolk CCG, Suffolk County Council and West Suffolk NHS Foundation Trust. Our model has been created by a wide range of partners as part of the Suffolk Health and Care Review, including service users, Healthwatch Suffolk, health and care providers, health and care commissioners, voluntary and community sector partners and district and borough councils.

Our strategy has four main objectives,which are aligned to the wider public sector reform agenda in Suffolk. Firstly, people manage their own health and social care with the right support when needed; secondly, our communities are easy andsupportive places to live with a health or care need; thirdly, our health and care providers are co-ordinated by one clinically-led organisation (our PACS model) and; fourthly, higher cost interventions are replaced with lower cost.

Our new organisation will combine acute, community, 111 and GP out of hours services into one legal entity and establish governance links with primary and social care. The new organisation, the West Suffolk Health and Care Organisation, will have headquarters co-located with West Suffolk Councils.

Our operating model is locality focused, building on Suffolk County Council’s Supporting lives, connecting communities transformation programme for adult community services. We plan to have six Integrated Neighbourhood Teams of health and care professionals in West Suffolk supported by Neighbourhood Networks (including our voluntary and community sector providers).

Our governance model will support a locality approach by delegating resources to our localities, each with a clinical director, who reports into the System Executive Group and the Board of West Suffolk Health and Care. Primary and secondary care clinicians are in the majority on the executive. The Board has a Council of Governors and public membership scheme to ensure our community and stakeholders have a clear role and voice. Our legal structure for developing the model will be the Foundation Trust to give our community and stakeholders a clear role and voice.

Our financial strategy is based upon a capitated payment mechanism from commissioners. We will move away from performance by results for the West Suffolk GP list based requirements. Choice would still apply – there would be tariff for activity outside West Suffolk – but we aim to repatriate activity. Efficiency would be through prevention, early intervention and the right care in the right place, as well as corporate running cost savings. There will be collective agreement on investment and disinvestment in local services. Using international comparisons we would expect to deliver cost per capita reductions in the region of 15-10 per cent.

Our foundations are strong. We have excellent award winning services in West Suffolk. And if we are going to meet the challenges of the future we need to get on and do this quickly. This is why our timeline is to move to shadow running in 2015/16 and establish the new organisation in 2016/17. So let’s get on with it!

Professor Dr Stephen Dunn, Chief Executive, West Suffolk NHS Foundation Trust



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